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Wednesday, April 1, 2015

Saying hello and goodbye on the maternity ward- By Rebekah and Karen

This week Karen and I (Rebekah) were very excited to practice on the maternity ward. We started our first day like any other day by helping the nurses with routine ward cleaning. During the cleaning, Karen noticed a postpartum mother who was actively bleeding and passing clots. By the time I rushed over to help, Karen was lowering the mother to the floor as her consciousness was decreasing rapidly. It was in this moment that we knew we were going to manage this postpartum hemorrhage independently. According to the World Health Organization, "postpartum hemorrhage is the leading cause of maternal mortality in low income countries and the primary cause of 1/4 of all maternal deaths globally" (2012). Knowing the seriousness of this postpartum complication, we knew we needed to stop the bleeding quickly and effectively. In the back of our minds, we also knew that if this mother lost too much blood she would require a blood transfusion to survive. However, we both knew that the blood bank at the hospital was empty. We were able to rely on our knowledge and nursing instinct to manage this obstetrical emergency. After an hour of interventions, the mother regained consciousness. By the end the shift, she was walking around the unit happily with her baby and was discharged home that day. This situation showed us that we are ready to be registered nurses back home in Canada. This was a rewarding feeling.

There was another mother on the ward who we also became concerned about. We found this mother moaning and crying in pain, we wanted to help her. When we asked the nurses what was happening with this mother, they explained to us that her full term fetus had died in utero. We realized that the mother was not receiving any emotional support from the nursing staff. This was not because the staff did not care, but it was perhaps because the ward is busy, and a stillborn babe is not considered a priority. Karen and I noticed that mothers here are expected to be strong, and it appears that comforting a mother displays a sign of weakness, that is not culturally desirable. We also noticed that the mothers labour was not induced to deliver the fetus for a few days. This left the mother in a prolonged stage of labour, knowing that her baby had passed. In Canada, a mother would never be left in this condition.

The flowing day, we started an oxytocin infusion on this mother to induce her labour. A short while after, we recognized her impending labour and whisked her into the delivery room. At first, it was just Karen and I in that delivery room, preparing ourself to deliver this still born. I remember looking at Karen and asking her "are you ready to do this?" Karen delivered the first half of the baby while I held the mother's hand and provided much needed emotional support. As the baby's head emerged, so did the very apparent physical deformities. A gush of brown and fowl smelling amniotic fluid came out with each contraction. The smell was like nothing we have ever smelled before. We could tell that the infant had been left too long in utero and was beginning to decay. The head delivered smoothly but the rest of the body did not. Because the baby was not alive, this made the progression of labour prolonged and it was difficult to deliver the shoulders. Karen and I tried very hard to do everything we could to deliver the baby in a way to protect the dignity if the body. This was not the case when the doctor came in to finish the delivery. It was very hard to watch him pull the head of the baby with enough force to deliver but also enough force to snap the neck of the babe. When the baby was finally delivered it was not like the deliveries we had experienced before. At this point there were eight people in the room watching us deliver, and it was so quiet you could hear a pin drop. I remember holding the hand of the mother and seeing her face, knowing that she was beginning to accept the reality of her loss. It was a difficult delivery to participate in, but we are both grateful for the opportunity to support this mother.

As we have been told many times before, in Africa there are many highs and there are many lows. The stillborn experience was a low but we had the high of delivering seven healthy babies. Karen and I had so much fun in the delivery rooms. When one of us would deliver, the other would support the mother by yelling kasha ahulu (meaning push mamma). Unlike Canada, where screaming and grunting indicates the second stage of labour, mothers here do not make a sound. So Karen and I filled the silence with encouragement and praise for the mammas (the nurses would laugh at our enthusiasm). Many of our mammas were very young and came from poor villages. In Mongu, mothers are expected to bring their own supplies for their delivery. Including their own cleaning supplies to clean the delivery room after birth. We had the pleasure of giving these mothers in need mother-and-baby packages. These packages are made from the donations we received from the Kelowna community. It has been amazing to see how these donations truly make an impact globally.

A new born dressed and wrapped up in our donations from Kelowna.

Karen and her first healthy baby she delivered

Rebekah and her first healthy baby she delivered (yes we were sweating as much as those mothers in labour!)

Karen performing a neonatal assessmnet post delivery

For me (Rebekah) this week has been and will continue to be the highlight of my time here in Mongu. This week was very special and exciting for me because of my passion for maternal and child health. It was so rewarding to have the opportunity to apply my specialized knowledge of labour and delivery in this practical setting. I will never forget my first delivery this week. I was so relieved to hear the cry of the little babe, knowing that he was healthy and that I had accomplished a safe delivery. The opportunity to share this beautiful moment with a mother and family is why I love maternity nursing. It is an incredible feeling to be practicing in the field of nursing that you are passionate about.... I wish I could put this feeling into words for you all. I look forward to taking my experiences on the maternity ward here and applying them to my nursing practice in this specialty in Canada.

Lastly, throughout all our experiences on the maternity ward, we were able to develop strong relationships with the nurses and midwives. This week we had the opportunity to share our perinatal knowledge and advocate for best nursing practice on the ward. This knowledge was well received, and the nurses and midwives were always asking questions to learn. We in turn, also learned a great deal from the midwives and nurses. This lead to a collaborative partnership between ourselves and the staff members. We felt so welcomed and appreciated on the ward and we are grateful for the diverse learning opportunities we experienced.

2 comments:

You two girls most certainly had a big range of experiences in 3 short days! High and Lows for sure. The stillborn birth would no doubt be a difficult one to have to see. So wonderful to hear of the support and comfort you were able to give the mom who was grieving. This is the true heart of a sincere nurse. Great to hear that 7 healthy babies arrived!! Lovely to be able to share some donations from Canada. Always a joy to give especially to those in need. Fantastic job girls...you make Canada proud!

I can imagine how thrilled you were to take part in these births - it brings back memories for me of outback nursing in Australia in the late 70's when we rarely had a doctor available and only one very overworked midwife.

Yet, delivering babies would be outside the scope of practice for most registered nurses in Canada without advanced specialty training - and therefore, not possibly something you will experience again - nor would you want to, if things were to suddenly start to go wrong, as they so easily and quickly can in childbirth - even when all seems "normal". What sticks with me, therefore, is the experience you had with the mother in PPH - because there is little doubt that your nursing vigilance and knowledge saved her life.

Surely the biggest thrill of all - to know that thanks to your watchful attention and knowledge of the post partum period, you recognized and responded effectively to a life threatening event - and thanks to your actions, a newborn baby still has his or her mother - and thus a better chance at life in a hard world. So whether you ever get to deliver another baby or not - I hope you never forget the difference your nursing knowledge and oversight made - because wherever you practice in future, that is what your patients will need from you most.